• Debora Pezzini, Jawed Nawabi, Frieder Schlunk, Qi Li, Federico Mazzacane, Giorgio Busto, Elisa Scola, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Michele Laudisi, Anna Cavallini, Aristeidis H Katsanos, Ashkan Shoamanesh, Andrea Zini, Ilaria Casetta, Enrico Fainardi, Andrea Morotti, and Alessandro Padovani.
• Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. d.pezzini@unibs.it.
• Neurocrit Care. 2024 Apr 1; 40 (2): 707714707-714.

BackgroundHematoma expansion (HE) is common and predicts poor outcome in patients with supratentorial intracerebral hemorrhage (ICH). We investigated the predictors and prognostic impact of HE in infratentorial ICH.MethodsWe conducted a retrospective analysis of patients with brainstem and cerebellar ICH admitted at seven sites. Noncontrast computed tomography images were analyzed for the presence of hypodensities according to validated criteria, defined as any hypodense region strictly encapsulated within the hemorrhage with any shape, size, and density. Occurrence of HE (defined as > 33% and/or > 6-mL growth) and mortality at 90 days were the outcomes of interest. Their predictors were investigated using logistic regression with backward elimination at p < 0.1. Logistic regression models for HE were adjusted for baseline ICH volume, antiplatelet and anticoagulant treatment, onset to computed tomography time, and presence of hypodensities. The logistic regression model for mortality accounted for the ICH score and HE.ResultsA total of 175 patients were included (median age 75 years, 40.0% male), of whom 38 (21.7%) had HE and 43 (24.6%) died within 90 days. Study participants with HE had a higher frequency of hypodensities (44.7 vs. 24.1%, p = 0.013), presentation within 3 h from onset (39.5 vs. 24.8%, p = 0.029), and 90-day mortality (44.7 vs. 19.0%, p = 0.001). Hypodensities remained independently associated with HE after adjustment for confounders (odds ratio 2.44, 95% confidence interval 1.13-5.25, p = 0.023). The association between HE and mortality remained significant in logistic regression (odds ratio 3.68, 95% confidence interval 1.65-8.23, p = 0.001).ConclusionEarly presentation and presence of noncontrast computed tomography hypodensities were independent predictors of HE in infratentorial ICH, and the occurrence of HE had an independent prognostic impact in this population.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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